NZ needs a more nuanced discussion about suicide

The new head of the Ministry of Health’s Suicide Prevention Office has her work cut out for her, as she tries to bring the public along on a more nuanced conversation about suicide

New Zealand has horrific suicide rates. It’s something we, thankfully, now talk about openly with a view to turning the tide.

And while most people can tell you our suicide rate continues to rise year-on-year and our youth rate is one of the worst in the OECD, you’d likely be hard-pressed to find an everyday Kiwi who can talk to you about the complex and multiple drivers and risk factors that play a part in people taking their own lives.

The new lead of the Suicide Prevention Office, Carla na Nagara, says a discussion about these risk factors and what needs to be done to address them cannot be covered in a simple soundbite or “tabloid-level journalism”.

But the former Manawatū coroner says a more complex and nuanced conversation will start the ball rolling on turning the tide.

“I’m not comfortable that the current narrative in the public domain, around suicide causes and prevention, is always accurate or safe," she told Newsroom in her first major round of media interviews, just a fortnight into the job.

This is a confronting sentiment. While New Zealand is finally talking about suicide, na Nagara’s experience is telling her those conversations aren’t always helpful.

“My impression is that things get oversimplified, often....

“The point people need to understand is that our rate’s not going to come down unless there’s an across-the-board approach. It’s not simply throwing money at services and everything will be OK, because suicide has its drivers, not just in mental illness.”

Half of those who kill themselves do not have a mental health diagnosis, or issue.

But as a country, we continue to conflate mental illness and suicide, and while there are connections and mental illness is a risk factor, it's not the whole picture.

Speaking about cases she dealt with, na Nagara said: “They may have been distressed, there may have been really chronic risk factors, there might have been acute risk factors on top of that, which led to them ending their lives.”

Over the past year, there has been more of an understanding from government that socio-economic deprivation, colonisation, adverse childhood events, and trauma all play a part.

This wasn't new to people working in this space, but na Nagara said she felt for the first time there was a Government ready to name these issues, and commit funding to address the problem.

The next major appointment to the office will be a senior Māori advisor.

In May, the health minister and prime minister announced their response to the mental health and addictions inquiry. This was followed up with a major budget announcement, and the delivery of the long-awaited Suicide Prevention Plan and Suicide Prevention Office. Photo: Lynn Grieveson

In the 2019 financial year, 685 people died by suicide, rising from 668 the previous year. The rate of deaths per 100,000 people rose from 13.7 to 13.9.

At the time the numbers were released, delays in setting a national strategy on suicide prevention and appointing leadership were felt keenly throughout the sector. The Government announced $1.9 billion over four years for mental health, but just $40m was targeted specifically at suicide prevention.

The 10-year strategy, with a five-year action plan, was seen as a middle ground after backlash over a lack of a specific plan for Māori.

The Māori Council was angry over the lack of a Māori-specific plan but the Government anticipated this, and brought along Māori suicide prevention advocate Mike King for the announcement. The final plan was seen as a middle ground.

King, who had previously been critical of the draft plan, seemed to have come around.

The plan identifies eight key areas for change, and includes the provision for the Suicide Prevention Office tasked with implementing the plan, now headed by na Nagara.

But all was not calm behind the scenes.

That day in September was also supposed to mark the announcement of na Nagara’s appointment, but Newsroom understands King’s disapproval stopped that going ahead.

There have been other controversies in this space, with the head of the Māori Council, Matthew Tukaki, breaking the embargo on this year’s suicide statistics. And King’s campaign to gather 1000 suicide notes for his charity to analyse. Something that's been labelled by some as unsafe.

“There’s nothing in it for anyone in the suicide prevention space if there’s fighting, or a refusal to work [together]. What we need, fundamentally, are safe evidence-based approaches to suicide prevention.”

Fractures within the suicide prevention community are nothing new.

However, na Naga said she hoped she would be able to bring advocates together to achieve a common goal.

“I’m really looking forward to working with everybody who has an interest in bringing our suicide rate down. There are a lot of people, with a lot of passion, in this suicide prevention area.”

She acknowledged the current clashes.

“But I would like to think that over time, constructive relationships will be developed, because what is important is that lots of people need to be involved...

“There’s nothing in it for anyone in the suicide prevention space if there’s fighting, or a refusal to work [together].

The prevention plan and office come off the back of the national mental health and addictions inquiry.

While the Government accepted the majority of the inquiry’s recommendations, Health Minister David Clark flatly refused to set a suicide reduction target.

This has always raised the question: how do we measure success?

“At the most simplistic, success will look like the rate starts to track down. And if it doesn’t, then I think we need to take a really good look at the work that’s being done and see what we’re missing.”

Na Nagara also refused to set any operational targets.

“We’ll never think we’ve got there until there’s no suicide. I take that as being implicit,” she said.

“There’s no number of suicide that would be fundamentally considered acceptable. Even if there isn’t the articulation of a target, implicit in the work is that aspiration that we will be able to become a society where taking your own life isn’t considered an option.”

But most working in this space would accept this aspirational goal is not a realistic one. When pushed on this point, she said:

“At the most simplistic, success will look like the rate starts to track down. And if it doesn’t, then I think we need to take a really good look at the work that’s being done and see what we’re missing.”

Na Nagara said it would take more than a year or two, to turn the ship around. And this was something everyone had to take responsibility for.

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